The role of sexual health services
Rising levels of sexually transmitted infections (STI) have led many local education authorities to recognise the need for comprehensive sexual and relationship education. Meanwhile, many hard-to-reach young people are being contacted through pupil referral centres, youth offending teams and leaving care teams.
Topics covered include the factors that influence young people in their ability to form and maintain relationships. This may include discussion on how to say “no” to unwanted attention and sex.
The risks associated with unprotected intercourse should also be highlighted, raising awareness of how to access local sexual health services and how to gain the knowledge and skills to practice safer sex.
Other areas to cover include the prevalence of STIs and HIV, how they are spread and how to minimise the risk of an unwanted pregnancy.
In some areas, outreach teams may offer a trip to sexual health clinics or run virtual clinics.
Sex and the law
Although the age of consent for sexual intercourse is 16, a doctor or other professional can advise or treat someone under 16 without their parents’ knowledge or consent if they meet the Fraser guidelines, named after Lord Fraser who stood in judgement in 1985 in the case of Victoria Gillick, who objected to her under-16-year-old daughter being prescribed contraception without parental consent. The five guidelines are:
● The young person will understand the advice.
● S/he can’t be persuaded to tell parents.
● S/he is likely to have sex anyway.
● His/her physical or mental health would suffer without the advice or treatment.
● His/her best interests require it.
The Best Practice Guidance (DH 2004) highlighted the benefit of establishing a rapport with the young person who is engaged in sexual activity by giving support and time to make an informed choice. This can be done by discussing emotional and physical risks, and coercion or abuse and the benefits of talking to the GP, parent or other adult (especially in cases of abortion referral).
Best practice within sexual health clinics maintains that all clients have a right to a confidential service. Anyone treated for an STI should only have their identity disclosed to someone involved in their treatment or preventing the spread of infection (NHS trusts 2000).
Contraception and young people
Condoms remain the most popular first method of contraception used by young people, probably due to their high accessibility. In some areas, schools and colleges will supply condoms to pupils.
The combined contraceptive pill is probably the most popular hormonal method of contraception. This is prescribed free, and as with all consultations, confidentially – even if the person is under 16, so long as they meet the Fraser guidelines (see above). Hormonal methods of contraception do not protect against STI and HIV – condoms should always be used.
For emergency contraception, the most common form is the one-off progesterone-only pill. It has to be taken within the first 72 hours of unprotected sex. This is widely available, including from some pharmacies and via school nurses.
Taking action to prevent abuse
British Association for Sexual Health and HIV (BASHH) guidance from 2003 advises to question and check that there has been no coercion (especially when there are large age differences between sexual partners), exploitation, rape or other abuse. Child protection referral procedures should be used for under-18s in these situations.
Working Together (April 2006) advises professionals to use a concern checklist when dealing with young people engaged in a sexual relationship, but also retain a professional discretion. For those young people under 13 who have disclosed sexual activity, it is vital to:
● Consult the child protection lead.
● Presume that you will always refer except in exceptional circumstances.
● If a decision is made not to refer, keep full records of reasons for the decision.
● Note that an assessment must be made in more depth than usual, and that the threshold for referral is much lower.
It is important to note that Home Office Sexual Offences Act guidance states that although the age of consent is 16, it is not intended that the law should be used to prosecute mutually-agreed teenage sex between two young people of a similar age, unless it involves abuse or exploitation.
Help and advice for young people is available at genito-urinary (GUM) clinics, Brook advisory clinics, GP services and the Terrence Higgins Trust.